Student Monitoring C6 Form

Section 1 – to be completed by the student

Student ID Number	Surname

First Name	Course code ‘AT RISK’

Please submit one form per course
Your University e-mail address

Please explain, giving clear concise details, the reasons why you were unable to attend classes and what actions you are proposing to make up missed work (this field is limited to 800 characters).

Once you have completed all the fields in section 1 please submit this form as per the instructions issued by your school, these instructions can be found here. If you have a medical certificate or a letter from the Counselling Service explaining your continuous absence then please submit it along with this form. You should note that while the University wishes to support students experiencing personal or medical problems which are impacting on a student’s studies, it is only possible to remain registered on a course if you are able to achieve the learning outcomes by making up missed work. The Course Co-ordinator may contact you if they require more information or they may wish to meet with you to discuss your current situation.

Section 2 – to be completed by the Course Co-ordinator

Course Co-ordinators decision	Reinstate	Do NOT reinstate

Where reinstate agreed, please state agreed remedial action and associated timescales (this field is limited to 500 characters)

Section 3 – staff use only
Medical certificate attached	Yes	No	Date form received.

Counselling letter attached	Yes	No

Total number of teaching session missed of which are GC are MC

Sent to Course Co-ordinator	Date student notified